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<head>
<title>Sample form for use with formmail.php</title>
</head>
<body>
<p>This form demonstrates the use of formmail.php.
<br />Note that formmail.php requires a one line change
to work.  Use a text editor to read the information
at the top of formmail.php.
</p>
<p>Also, you need to change this form using a text editor;
follow the 4 simple steps shown in the comments.
</p>
<p>We've included sample fields to show you how to
submit Checkboxes, Radio Buttons, Multi-selection
List Boxes, normal Text fields, and Text Areas.
</p>
<p>
For full information and support, visit
<a href="http://www.tectite.com/">www.tectite.com</a>
</p>
<p></p>
    <!-- STEP 1: Put the full URL to formmail.php on your website in the 'action' value. -->
<form method="post" action="http://www.thebna.org/formail/formmail.php" name="SampleForm">
    <input type="hidden" name="env_report" value="REMOTE_HOST,REMOTE_ADDR,HTTP_USER_AGENT,AUTH_TYPE,REMOTE_USER">
    <!-- STEP 2: Put your email address in the 'recipients' value.
                 Note that you also have to allow this email address in the
                 $TARGET_EMAIL setting within formmail.php!
    -->
    <input type="hidden" name="recipients" value="chris.keith@gmail.com" />
    <!-- STEP 3: Specify required fields in the 'required' value -->
    <input type="hidden" name="required" value="email:Your email address,realname:Your name" />
    <!-- STEP 4: Put your subject line in the 'subject' value. -->
    <input type="hidden" name="subject" value="BNA Testing" />

    <table border="1" cellspacing="5%">
    <tr>
        <td>
        <p>Please enter your name:</p>
        </td>
        <td><input type="text" name="realname" />
        </td>
    </tr>
    <tr>
        <td>
        <p>Please enter your email address:</p>
        </td>
        <td><input type="text" name="email" />
        </td>
    </tr>
    <tr>
        <td><p>May we contact you?</p>
        </td>
        <td>
            Yes <input type="radio" name="contact" value="Y" checked />
            No <input type="radio" name="contact" value="N" />
         </td>
    </tr>
    <tr>
        <td><p>What are your favourite colours?</p>
        </td>
        <td>
            Red     <input type="checkbox" name="colors[]" value="red" />
            Blue    <input type="checkbox" name="colors[]" value="blue" />
            Yellow  <input type="checkbox" name="colors[]" value="yellow" />
         </td>
    </tr>
    <tr>
        <td valign="top"><p>What vehicles do you have a license to operate?</p>
        </td>
        <td valign="top">
            <select name="vehicles[]" multiple size="5">
                <option value="Car">Car</option>
                <option value="Bus">Bus</option>
                <option value="Truck">Truck</option>
                <option value="Plane">Aeroplane</option>
                <option value="Boat">Boat</option>
            </select>&nbsp;(Select all that apply; use CTRL-click to select)
         </td>
    </tr>
    <tr>
        <td valign="top">
        <p>Please enter your message:</p>
        </td>
        <td><textarea name="mesg" rows="10" cols="50"></textarea>
        </td>
    </tr>
    <tr>
        <td><input type="submit" value="Submit" /></td>
        <td></td>
    </tr>
    </table>
</form>
<!--
    Please support the ongoing development of FormMail and our other
    freeware products by keeping the following text on your form
    (or placing it elsewhere on your website).  Thanks!
-->
<small>This form and its 
<a href="http://www.tectite.com/">form processor</a>
supplied by www.tectite.com.
</small>
</body>
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